6 lessons learned from implementing team-based care
Clinician burnout has been an issue for years, and is a complex, systemic problem. Evidence tells us that it decreases the quality of care and damages the patient experience. Fixing it will take more than just improving the electronic health record (EHR).
One of our clients, Mankato Clinic (Mankato, Minnesota, U.S.A.) addressed this problem with a new approach to care. The organization recognized that the requirements placed on clinicians have increased, and it implemented team-based care to spread the workload and ease frustration.
A recent case study shares Mankato Clinic’s journey with team-based care. Here are some of the lessons learned from undertaking this organizational shift:
1) Build from the ground up. “We’ve learned that a team-based approach has to come from the ground up,” Chief Medical Officer Andrew Lundquist, DPM said. “You have to look at processes, workflows and interactions for everyone – from schedulers, to nurses, to physicians, to patient services – everyone has to work in a little different way.”
2) Give it time to work. “The first two or three months, it won’t feel like it’s easier,” said EHR Clinical Analyst Becky Anderson, LPN. “In talking with providers, it seems to click around the six-month mark…they’re feeling comfortable and spending fewer evening and weekend hours on work.”
3) Co-location is key. Each team at Mankato Clinic has one provider and two nurses, and are more effective when they share a workspace. “They are in a shared office with their desks together and a shared phone line,” Anderson said. “They’re sitting side by side, authoring that note together, which really reinforces what the provider wants.”
4) Education should be continuous. “Once you leave the scheduled EHR training time, you’re not done. There should be continuous education between the provider, nurses and analysts,” said Director of Health Information, EHR and Quality Resources Cheryl Jones.
5) Specify placement of coding. “How the notes are constructed, and how the codes are placed plays into reimbursement,” Jones said. Mankato Clinic added a four-hour training where the coding manager talks through the note and explains how many elements are needed for coding and billing purposes.
6) Have guardrails. Providers each have their own preferences when working with patients, and it’s important to give flexibility within the constructs of the program. But it’s equally important to establish boundaries. “We use guardrails and systems so team-based care works well for everyone,” Dr. Lundquist said.
Mankato Clinic’s team-based care reminds me so much of what we did with Allscripts TouchWorks® EHR in my practice back in Walla Walla, Washington, to protect the patient-clinician interaction. Team-based care is great for patients, clinicians and the practice. For example, proactively anticipating care needs will mean more coordinated care for patients, fewer things for clinicians to remember, and increased revenue for the organization.